The role of drug-induced sleep endoscopy for positive airway pressure titration – initial results


Authors: M. Masárová 1,2;  J. Seko 1;  M. Plášek 1,2;  M. Formánek 1,2;  O. Jor 3;  V. Novák 4;  P. Komínek 1,2;  P. Matoušek 1,2
Authors‘ workplace: Klinika otorinolaryngologie a chirurgie, hlavy a krku LF OU a FN Ostrava 1;  Katedra kraniofaciálních oborů, LF OU, Ostrava 2;  Klinika anesteziologie, resuscitace, a intenzivní medicíny FN Ostrava 3;  Centrum pro poruchy spánku, a bdění – spánková laboratoř, Oddělení dětské neurologie, FN Ostrava 4
Published in: Cesk Slov Neurol N 2021; 84/117(2): 183-187
Category: Original Paper
doi: 10.48095/cccsnn2021183

Overview

Aim: The aim of the work was to monitor the effect of positive airway pressure (PAP) on the particular sites of obstruction during the drug-induced sleep endoscopy to evaluate at which pressure the obstruction disappears/worsens and to clarify possible reasons for PAP intolerance. Materials and Methods: In the period from 6/2018 to 12/2020, a PAP test was performed during the drug-induced sleep endoscopy in 20 patients with obstructive sleep apnea without previous therapy. During the examination, sites of obstruction in the upper respiratory tract were identified. It was evaluated how the different pressure set during PAP ventilation reflects on the behaviour of the upper respiratory tract, and on its expansion or collapse leading to its obstruction. Monitoring was started at a pressure of 6 hPa, and gradually the pressure was increased stepwise by 2 hPa in the range from 6 to 18 hPa. Each pressure was applied for a minimum of 20 s. The findings were evaluated using the VOTE classification according to Kezirian and compared with each other. Results: The best effect of PAP was observed in the case of anteroposterior obstruction in the soft palate area, where the average opening pressure was 11.2 hPa. For laterolateral oropharyngeal obstruction, the average opening pressure was 12 hPa. PAP had no effect in 8/20 patients, 6 times due to concentric or laterolateral obstruction of the soft palate, and twice due to the collapse of the epiglottis. In the collapsing epiglottis, PAP ventilation does not relax the airways, because with increasing PAP pressure, the obstruction and suction of the epiglottis on the posterior wall of the pharynx worsens. Conclusion: Drug-induced sleep endoscopy of the upper airways with PAP is a simple and easy-to-perform examination which can reduce PAP intolerance (e.g., in the event of an epiglottis collapse) and thus optimize the treatment. We assume better compliance of the pressure device in patients who are indicated for this treatment.

Keywords:

drug-induced sleep endoscopy – obstructive sleep apnea – flexible endoscopy – positive airway pressure


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Paediatric neurology Neurosurgery Neurology

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Czech and Slovak Neurology and Neurosurgery

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